CLUBBING SIGN AND

CYANOSIS
 Clubbing Sign
 Nail clubbing, also known as digital clubbing,
is a deformity of the finger or toe nails
associated with a number of diseases, mostly of
the heart and lungs. ... Hippocrates was the
first to formally document clubbing as
a sign of disease, and the phenomenon is
therefore occasionally called "Hippocratic
fingers."
 MECHANISM
 Platelet Derived
 Chronic Hypoxia
 Hormonal
 Platelet Derived
 Chronic inflammation
 Release of acute phase reactants
 Inc. platelet derived growth factor
 Proliferation of soft tissue of nail bed
 Chronic hypoxia
 Systemic vasodilatation
 Inc. blood supply to extremities
 Soft tissue proliferation of nail bed
 Hormonal
 Inc. growth hormone (acromegaly etc.)
 Inc. soft tissue growth
 Inc. ectroge leades to inc. vasodilatation
DIFFERENT STAGES OF CLUBBING
 Clubbing may be associated with various clinical
conditions however, lung diseases are most
commonly associated with clubbing and neoplastic
lung disease is the most common pulmonary cause
of clubbing.
 Other lung diseases that can be associated with
clubbing are bronchiectasis, lung abscess, interstitial
lung disease, fibrous pleural tumors, mesothelioma,
etc.
 Other diseases are cardiac conditions (namely,
cyanotic heart diseases, infective endocarditis) and
gastrointestinal diseases (namely, inflammatory
bowel disease, coeliac disease, cirrhosis mostly
primary biliary cirrhosis).
 UNILATERAL CLUBBING
 Clubbing is generally bilateral, but in some
conditions it may occur unilaterally
 PSEUDOCLUBBING

 Pseudoclubbing is defined as an overcurvature

of the nails in both the longitudinal and
transverse axes, with preservation of a normal
Lovibond angle.
 Pseudoclubbing may be distinguished
clinically from clubbing by the preservation of
the nail-fold angle and bony erosion of the
terminal phalanges on radiography.
 CYANOSIS
 Cyanosis refers to a bluish cast to the skin and
mucous membranes. Peripheral cyanosis is
when there is a bluish discoloration to your
hands or feet. It's usually caused by low
oxygen levels in the red blood cells or problems
getting oxygenated blood to your body
 Normal level of Oxygen in blood is 15g/dL
 In females it ranges from 12-16g/dL
 In males it can be upto 18g/dL
 If there is 5.3-6g/ deoxyhaemoglobin in blood
1. Defficient oxygenation of blood in lungs
 Pneumonia
 Chronic bronchitis
2. Decreased oxygen transfer across alveolar
capillary membrane
 Fibrosing alveolitis
3. Decreased amount of air ventriculation in lungs
 polio
 TYPES
 Central
 Peripheral
 CENTRAL
 Central cyanosis is often due to a circulatory or
ventilatory problem that leads to poor blood 
oxygenation in the lungs. It develops when
arterial oxygen saturation drops below 85% or
75%.
 Bluish cast around the lips, tongue and central
core
1. Cardiac
 CHF (congestive heart failure)
 Eisenmenger’s disease
 MI
2. CNS
 Intracranial haemorrhage
 Tonic clonic seizure
 Drug overdose
3. Respiratory
 COPD
 Hypoventilation
 Pulmonary hypertenstion
 Pulmonary embolism
4. High altitude
 >2400m
5. Blood
 Primary polycythemia
 Congenital cyanosis
6. Temperature
 hypothermia
 Peripheral
 Due to inadequete or obstructive blood
circulation
 No clubbing
 Cold
 Cardiac failure
 Collapse
 Constriction
 Hypovolemia
 Arteriolar or venous constriction
 Differential Cyanosis
 Differential cyanosis is defined as a difference
in oxygen saturation of at least 5% or a
difference in partial pressure of oxygen of at
least 20 mm Hg between the arms and legs
associated with congenital heart disease or
persistent pulmonary hypertension of the
newborn (PPHN).
 PDA
Patent ductus arteriosus
Reversal of shunt
Seen in newborns
Failure of ductus arteriosus to close